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MacEwan SR, Olvera RG, Jonnalagadda P, Fareed N, McAlearney AS. Patient and Provider Perspectives About the Use of Patient-Generated Health Data During Pregnancy: Qualitative Exploratory Study. JMIR Form Res 2024; 8:e52397. [PMID: 38718395 PMCID: PMC11112476 DOI: 10.2196/52397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/22/2023] [Accepted: 03/27/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND There is increasing interest in using patient-generated health data (PGHD) to improve patient-centered care during pregnancy. However, little research has examined the perspectives of patients and providers as they report, collect, and use PGHD to inform obstetric care. OBJECTIVE This study aims to explore the perspectives of patients and providers about the use of PGHD during pregnancy, including the benefits and challenges of reporting, collecting, and using these data, as well as considerations for expanding the use of PGHD to improve obstetric care. METHODS We conducted one-on-one interviews with 30 pregnant or postpartum patients and 14 health care providers from 2 obstetrics clinics associated with an academic medical center. Semistructured interview guides included questions for patients about their experience and preferences for sharing PGHD and questions for providers about current processes for collecting PGHD, opportunities to improve or expand the collection of PGHD, and challenges faced when collecting and using this information. Interviews were conducted by phone or videoconference and were audio recorded, transcribed verbatim, and deidentified. Interview transcripts were analyzed deductively and inductively to characterize and explore themes in the data. RESULTS Patients and providers described how PGHD, including physiologic measurements and experience of symptoms, were currently collected during and between in-person clinic visits for obstetric care. Both patients and providers reported positive perceptions about the collection and use of PGHD during pregnancy. Reported benefits of collecting PGHD included the potential to use data to directly inform patient care (eg, identify issues and adjust medication) and to encourage ongoing patient involvement in their care (eg, increase patient attention to their health). Patients and providers had suggestions for expanding the collection and use of PGHD during pregnancy, and providers also shared considerations about strategies that could be used to expand PGHD collection and use. These strategies included considering the roles of both patients and providers in reporting and interpreting PGHD. Providers also noted the need to consider the unintended consequences of using PGHD that should be anticipated and addressed. CONCLUSIONS Acknowledging the challenges, suggestions, and considerations voiced by patients and providers can inform the development and implementation of strategies to effectively collect and use PGHD to support patient-centered care during pregnancy.
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Affiliation(s)
- Sarah R MacEwan
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Ramona G Olvera
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Pallavi Jonnalagadda
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Naleef Fareed
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, United States
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Ann Scheck McAlearney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, United States
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
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Topaloğlu Ören ED, Ünsal Avdal E, Polat G, Sofulu F, Düzgün G, Pamuk G. Experiences of women with gestational diabetes about fear of having diabetes in their babies: A qualitative study. Medicine (Baltimore) 2024; 103:e37755. [PMID: 38608114 PMCID: PMC11018210 DOI: 10.1097/md.0000000000037755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/08/2024] [Indexed: 04/14/2024] Open
Abstract
Gestational Diabetes Mellitus is an important public health problem that often occurs during pregnancy. This study aimed to reveal the experiences of women with gestational diabetes regarding the fear of having diabetes in their babies. A qualitative research method was carried out with a phenomenological approach. The interviews had a semi-structured form and were recorded on an online/face-to-face voice recorder, and thematic content analysis was performed on the MAXQDA22. Following the inclusion criteria, 12 women with gestational diabetes from the 2 hospitals in the study were included, and in this way, the study reached saturation. As a result of the interviews, 4 main themes and one subtheme were obtained from coding. The main themes were "sugar baby," "risky child," "raising a fearful baby," and "problematic gene carrier." From the main theme of "problematic gene carrier," the subtheme of "pregnancies with problematic genes" was created. This research sheds light on the problems women with gestational diabetes experience with themselves and their babies, and how they deal with these problems. Women with gestational diabetes try to accept and cope with the diagnosis. This research shows that the women were worried about both themselves and their babies. Illuminating the experiences of women with gestational diabetes is part of an integrative care approach that will help increase quality care and treatment in endocrine clinics. More qualitative studies are needed to learn more about the experiences of women with gestational diabetes in endocrine clinics.
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Affiliation(s)
- Ekin Dila Topaloğlu Ören
- Izmir Katip Celebi University Faculty of Health Science, Department of Obstetrics and Gynecology Nursing, İzmir, Türkiye
| | - Elif Ünsal Avdal
- Izmir Katip Celebi University Faculty of Health Science, Department of Internal Medicine Nursing, İzmir, Türkiye
| | - Gökşen Polat
- Izmir Tinaztepe University Faculty of Health Science, Department of Internal Medicine Nursing, İzmir, Türkiye
| | - Funda Sofulu
- Izmir Katip Celebi University Faculty of Health Science, Department of Internal Medicine Nursing, İzmir, Türkiye
| | - Gönül Düzgün
- İzmir Tinaztepe University Faculty of Health Science, Department of First Aid and Emergency, İzmir, Türkiye
| | - Gülseren Pamuk
- Izmir Katip Celebi University School of Medicine, Department of Family Medicine, İzmir, Türkiye
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Agunwamba AA, Finney Rutten LJ, St Sauver JL, Agunwamba AO, Jacobson DJ, McGree ME, Njeru JW. Higher Rates of Cesarean Sections Found in Somali Immigrant Women in Minnesota. J Racial Ethn Health Disparities 2022; 9:1765-1774. [PMID: 34309817 PMCID: PMC9550004 DOI: 10.1007/s40615-021-01113-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/30/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to compare prenatal characteristics and postpartum outcomes among Somali and non-Somali women residing in Olmsted County. METHODS We reviewed the medical records for a cohort of Somali women (≥18 years old; N= 298) who had singleton births between January 2009 and December 2014 and for an age-matched non-Somali cohort (N= 298) of women residing in Olmsted County, Minnesota. Logistic regression models which accounted for repeated measures were used to assess differences in prenatal and postpartum outcomes between Somali and non-Somali women. RESULTS Somali women had a significantly higher odds of cesarean section (adjusted OR=1.81; 95% CI=1.15, 2.84). Additionally, Somali women had a significantly lower odds of postpartum depression (adjusted OR=0.27; 95% CI=0.12, 0.63). CONCLUSION The reported adverse postpartum outcomes have implications for interventions aimed at addressing perinatal care disparity gaps for Somali women immigrant and refugee populations.
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Affiliation(s)
- Amenah A Agunwamba
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First street SW, Rochester, MN, 55905, USA.
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First street SW, Rochester, MN, 55905, USA
| | | | | | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Michaela E McGree
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jane W Njeru
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Caputo A, Vicario CM, Cazzato V, Martino G. Editorial: Psychological Factors as Determinants of Medical Conditions, Volume II. Front Psychol 2022; 13:865235. [PMID: 35386893 PMCID: PMC8977586 DOI: 10.3389/fpsyg.2022.865235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrea Caputo
- Department of Dynamic and Clinical Psychology, and Health Studies, University of Rome "Sapienza", Rome, Italy
| | - Carmelo Mario Vicario
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Italy
| | - Valentina Cazzato
- School of Natural Sciences and Psychology, John Moores University, Liverpool, United Kingdom
| | - Gabriella Martino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Abolfathi M, Ashtarian H, Eskandari S, Irandoost SF, NeJhaddadgar N, Mirzaei N. Evaluation of quality of life in diabetic pregnant women. Prim Care Diabetes 2022; 16:84-88. [PMID: 34556436 DOI: 10.1016/j.pcd.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 11/24/2022]
Abstract
AIMS Gestational diabetes is the most common clinical complication during pregnancy. Women with gestational diabetes face many problems in their personal, family and social lives that affect their quality of life. The aim of this study was to evaluate the quality of life of diabetic pregnant women. METHODS This study was a descriptive study and the study population was all diabetic pregnant women referred to health centers in Kermanshah, Iran in 2019-2020. The studied variables were collected using a short form of quality of life questionnaire (WHOQOL-BREF-26 items). Then, with the help of SPSS software version 25, data analysis was performed based on frequency table and independent t-test. RESULTS 101 pregnant women with gestational diabetes were studied. Their mean age was 33.06 ± 05.05 years. The quality of life of all mothers participating in the study was above average. The average quality of life and psychological domains, social and environmental relationships of mothers were higher in people with higher incomes and employment, and also the average quality of life and psychological domains, social and environmental relationships were higher in mothers who had less than 6 months. CONCLUSIONS The majority of mothers were overweight (BMI = 25-29.9) and obese (BMI ≥ 30), which is one of the most important risk factors for gestational diabetes. Given the importance of quality of life of pregnant mothers, health policy makers are asked to provide more training for pregnant mothers on nutrition and increased physical activity to prevent gestational diabetes and improve their quality of life.
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Affiliation(s)
- Mitra Abolfathi
- Department of Health Education and Health Promotion, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Ashtarian
- Health Education Department, Faculty of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Soudabeh Eskandari
- Sleep Disorders Research Center, Kermanshah University of Medical Science, Kermanshah, Iran
| | - Seyed Fahim Irandoost
- PhD in Health Education and Health Promotion, Department of Public Health, School of Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Nazila NeJhaddadgar
- Department of Health Promotion and Education, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Nasim Mirzaei
- Department of Public Health, Firoozabad Branch, Islamic Azad University, Firoozabad, Iran
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Lis-Kuberka J, Orczyk-Pawiłowicz M. Polish Women Have Moderate Knowledge of Gestational Diabetes Mellitus and Breastfeeding Benefits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910409. [PMID: 34639709 PMCID: PMC8508017 DOI: 10.3390/ijerph181910409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 12/30/2022]
Abstract
Gestational diabetes mellitus (GDM) is a multifaceted disease and is associated with complications for newborns and mothers. The aim of the study was to assess Polish women’s knowledge concerning GDM and their attitude to breastfeeding. As a research tool, an anonymous online survey that included 33 questions, grouped into three main sections—sociodemographic and obstetric variables, risk factors for GDM and neonatal adverse outcomes, and knowledge about breastfeeding—was used and administered online. A total of 410 women aged from 18 to 45 participated in this study. Based on the survey, it was demonstrated that the women had moderate knowledge concerning the maternal risk factors and adverse neonatal outcomes associated with GDM and, additionally, the short- and long-term effects of breastfeeding. Significantly deeper knowledge about GDM, including breastfeeding by GDM mothers, was observed among hyperglycemic mothers in comparison to normoglycemic mothers. However, knowledge concerning the health benefits of breastfeeding was not related to the mothers’ glycemic status. In conclusion, educational programs must include pre-pregnancy education of women and place emphasis on explaining the mechanism of development of GDM and the transformation of GDM to type 2 diabetes. This is crucial for changing the public’s perception of GDM as a temporary, reversible clinical entity.
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Ghasemi F, Vakilian K, Khalajinia Z. Comparing the effect of individual counseling with counseling on social application on self-care and quality of life of women with gestational diabetes. Prim Care Diabetes 2021; 15:842-847. [PMID: 34215552 DOI: 10.1016/j.pcd.2021.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The present study aimed to compare the effect of two different forms of face-to-face and counseling on a social application, i.e., WhatsApp, on self-care and quality of life of women with gestational diabetes. METHODS The present research was an educational trial with control group, which was conducted on diabetic women between 24 and 26 weeks of pregnancy. A total of 126 subjects were included in the study using the convenient sampling method. They were assigned into three groups. All of the participants answered the questionnaires gestational diabetes self-care, and quality of life at the beginning and end of the study. The GATHER approach to counseling (G = Greeting, A = Ask, T = Tell, H = Help, R = Return) was performed in four 45-min sessions for face-to-face and WhatsApp groups in the pregnancy weeks of 27, 28, 29, and 30. The subjects in the control group received only the routine cares for gestational diabetes. T test, Chi squared test, and ANOVA repeated measurement test were used to analyze the data. RESULTS Findings showed a significant difference among the three groups in self-care and quality of life (p = 0.001). There was also a significant difference among the three groups in fasting blood sugar after the intervention (p = 0.005). CONCLUSION Self-care counseling, both in the form of face-to-face and on social networks, improved the score of self-care and quality of life as well as glucose tolerance test (GTT) in women with gestational diabetes.
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Affiliation(s)
- Fatemeh Ghasemi
- Arak University of Medical Sciences, School of Medicine, Arak, Iran.
| | - Katayon Vakilian
- Department of Midwifery, School of Medicine, Traditional and Complementary Medicine Research Center (TCMRC), Arak University of Medical Sciences, Basij Square, Sardasht Region, Peyambare-Azam Building, Arak, Iran.
| | - Zohre Khalajinia
- Department of Midwifery, School of Nursing and Midwifery, Qom University of Medical Sciences, Alley West 2, Thecher Street, Nursing Midwifery Department, Qom, Iran.
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Delanerolle G, Phiri P, Zeng Y, Marston K, Tempest N, Busuulwa P, Shetty A, Goodison W, Muniraman H, Duffy G, Elliot K, Maclean A, Majumder K, Hirsch M, Rathod S, Raymont V, Shi JQ, Hapangama DK. A systematic review and meta-analysis of gestational diabetes mellitus and mental health among BAME populations. EClinicalMedicine 2021; 38:101016. [PMID: 34308317 PMCID: PMC8283332 DOI: 10.1016/j.eclinm.2021.101016] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/02/2021] [Accepted: 06/21/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a common complication of pregnancy and is associated with an increased risk of mental health (MH) disorders including antenatal and postnatal depression (PND), anxiety and post-traumatic-stress-disorder (PTSD). We hypothesized GDM and MH disorders will disproportionately affect individuals from Black, Asian and Minority Ethnic backgrounds. METHODS A systematic methodology was developed, and a protocol was published in PROSPERO (CRD42020210863) and a systematic review of publications between 1st January 1990 and 30th January 2021 was conducted. Multiple electronic databases were explored using keywords and MeSH terms. The finalised dataset was analysed using statistical methods such as random-effect models, subgroup analysis and sensitivity analysis. These were used to determine odds ratio (OR) and 95% confidence intervals (CI) to establish prevalence using variables of PND, anxiety, PTSD and stress to name a few. FINDINGS Sixty studies were finalised from the 20,040 data pool. Forty-six studies were included systematically with 14 used to meta-analyze GDM and MH outcomes. A second meta-analysis was conducted using 7 studies to determine GDM risk among Black, Asian and Minority Ethnic women with pre-existing MH disorders. The results indicate an increased risk with pooled adjusted OR for both reflected at 1.23, 95% CI of 1.00-1.50 and 1.29, 95% CI of 1.11-1.50 respectively. INTERPRETATION The available studies suggest a MH sequalae with GDM as well as a sequalae of GDM with MH among Black, Asian and Minority Ethnic populations. Our findings warrant further future exploration to better manage these patients. FUNDING Not applicable.
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Affiliation(s)
| | - Peter Phiri
- Southern Health NHS Foundation Trust, United Kingdom
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, United Kingdom
| | - Yutian Zeng
- Southern University of Science and Technology, United Kingdom
| | | | - Nicola Tempest
- University of Liverpool, United Kingdom
- Liverpool Women's Hospital NHS Foundation Trust, United Kingdom
| | - Paula Busuulwa
- University of Liverpool, United Kingdom
- Liverpool Women's Hospital NHS Foundation Trust, United Kingdom
| | - Ashish Shetty
- University College London Hospitals NHS Foundation Trust, United Kingdom
- University College London, United Kingdom
| | - William Goodison
- University College London Hospitals NHS Foundation Trust, United Kingdom
| | - Hemananda Muniraman
- Department of Pediatrics, Creighton University Medical School, United Kingdom
| | | | | | - Alison Maclean
- University of Liverpool, United Kingdom
- Liverpool Women's Hospital NHS Foundation Trust, United Kingdom
| | | | - Martin Hirsch
- University College London Hospitals NHS Foundation Trust, United Kingdom
| | | | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, United Kingdom
| | - Jian Qing Shi
- Southern University of Science and Technology, United Kingdom
- Alan Turing Institute, United Kingdom
| | - Dharani K. Hapangama
- University of Liverpool, United Kingdom
- Liverpool Women's Hospital NHS Foundation Trust, United Kingdom
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Dalfrà MG, Burlina S, Del Vescovo GG, Anti F, Lapolla A. Adherence to a follow-up program after gestational diabetes. Acta Diabetol 2020; 57:1473-1480. [PMID: 32740702 DOI: 10.1007/s00592-020-01564-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/23/2020] [Indexed: 12/24/2022]
Abstract
AIM The aim of this study was to examine attendance for early postpartum follow-up among women with gestational diabetes mellitus (GDM), and to identify factors that influenced their likelihood of attending. METHODS One thousand eight hundred and nineteen women with GDM were retrospectively analyzed. During pregnancy, the following data were collected: age, family history of diabetes, ethnicity, prepregnancy BMI, fasting plasma glucose, glycated hemoglobin, gestational week of GDM diagnosis, timing and mode of delivery, newborn's birth weight and length. Glycemia and insulinemia during OGTT, lipid profile and postpartum BMI were assessed at follow-up. Based on the OGTT, women were classified as having normal glucose tolerance (NGT) or abnormal glucose tolerance (AGT), which included impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IFG + IGT, and DM2. Factors predicting postpartum attendance for follow-up and onset of AGT were considered. RESULTS Of the 889 (48.9%) who attended the scheduled postpartum OGTT, 741 (83.4%) had NGT, while 148 (16.6%) had AGT (IFG 6.7%, IGT 7.7%, IFG + IGT 0.8%, DM2 1.5%). The predictors of adherence to follow-up were: not belonging to an immigrant group; family history of DM2; and insulin therapy in pregnancy. The same factors were also predictive of AGT. Our data suggest a role of ethnicity in both attendance for postpartum follow-up and its outcome. CONCLUSION Despite efforts to provide care for women with GDM, postpartum screening rates are still low among Italian women, and especially among immigrants. Hence, the need to improve these patients' awareness of the severe risk of developing diabetes after pregnancy, concentrating efforts especially on women belonging to the most at risk ethnic groups.
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Affiliation(s)
- Maria Grazia Dalfrà
- Diabetology and Dietetics Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Silvia Burlina
- Diabetology and Dietetics Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Gloria Giovanna Del Vescovo
- Diabetology and Dietetics Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Francesca Anti
- Diabetology and Dietetics Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Annunziata Lapolla
- Diabetology and Dietetics Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
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Lee KW, Ching SM, Devaraj NK, Chong SC, Lim SY, Loh HC, Abdul Hamid H. Diabetes in Pregnancy and Risk of Antepartum Depression: A Systematic Review and Meta-Analysis of Cohort Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113767. [PMID: 32466479 PMCID: PMC7311953 DOI: 10.3390/ijerph17113767] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 12/18/2022]
Abstract
Previous literature has reported that patients with diabetes in pregnancy (DIP) are at risk of developing antepartum depression but the results have been inconsistent in cohort studies. We conducted a systematic review and performed a meta-analysis to quantify the association between DIP and risk of antepartum depression in cohort studies. Medline, Cinahl, and PubMed databases were searched for studies investigating DIP involving pregnant women with pre-existing diabetes and gestational diabetes mellitus and their risk of antepartum depression that were published in journals from inception to 27 December 2019. We derived the summary estimates using a random-effects model and reported the findings as pooled relative risks (RR) and confidence interval (CI). Publication bias was assessed using a funnel plot and was quantified by Egger and Begg’s tests. Ten studies, involving 71,036 pregnant women were included in this meta-analysis. The pooled RR to develop antepartum depression was (RR = 1.430, 95% CI: 1.251–1.636) among women with gestational diabetes mellitus. Combining pregnant women with pre-existing diabetes mellitus and gestational diabetes mellitus, they had a significant increased risk of developing antepartum depression (RR = 1.431, 95% CI: 1.205–1.699) compared with those without it. In comparison, we found no association between pre-existing diabetes mellitus in pregnancy (RR = 1.300, 95% CI: 0.736–2.297) and the risk of developing antepartum depression. This study has a few limitations: first, different questionnaire and cut-off points were used in evaluation of depression across the studies. Second, there was a lack of data on history of depression prior to pregnancy, which lead to confounding bias that could not be solved by this meta-analysis. Third, data were dominated by studies in Western countries; this is due to the studies from Eastern countries failing to meet our inclusion criteria for statistical analysis. Women with gestational diabetes mellitus have an increased risk of developing antepartum depression compared to those without the disease. Therefore, more attention on the mental health status should be given on pregnant women diagnosed with pre-existing diabetes mellitus and gestational diabetes mellitus.
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Affiliation(s)
- Kai Wei Lee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia; (K.W.L.); (N.K.D.)
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia; (K.W.L.); (N.K.D.)
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia
- Correspondence:
| | - Navin Kumar Devaraj
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia; (K.W.L.); (N.K.D.)
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia
| | - Seng Choi Chong
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia;
| | - Sook Yee Lim
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia;
| | - Hong Chuan Loh
- Clinical Research Centre, Hospital Seberang Jaya, Ministry of Health Malaysia, Perai 13700, Pulau Pinang, Malaysia;
| | - Habibah Abdul Hamid
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia;
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Lee KW, Ching SM, Hoo FK, Ramachandran V, Chong SC, Tusimin M, Ang FE, Mohd Nordin N, Devaraj NK. Factors associated with poor-to-moderate quality of life among pregnant women with gestational diabetes mellitus: a cross-sectional study in Malaysia. Qual Life Res 2020; 29:2725-2736. [PMID: 32430781 DOI: 10.1007/s11136-020-02532-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE This study aimed to identify factors associated with poor-to-moderate quality of life (QOL) among women with gestational diabetes mellitus (GDM) in two tertiary hospitals in Malaysia. METHODS A cross-sectional study was conducted among 526 pregnant women with GDM in two tertiary hospitals in Malaysia. Diabetes-related QOL was assessed using the Asian Diabetes Quality of Life Scale (AsianDQoL). Socio-demographic characteristics, glucose monitoring treatments for GDM, past obstetric history, concurrent medical problems and a family history of diseases were captured from patient records. A multiple logistic regression was used for analysis. RESULTS A total of 526 respondents with GDM entered the analysis. The median age of the respondents was 32 (interquartile range = 7) while 82.3% were Malay women. More than half of the respondents (69.5%) received an oral hypoglycaemic agent (OHA), and/or diet modification in controlling their GDM. The study reported that 23.2% of the respondents had poor-to-moderate QOL. Those with a family history of depression and/or anxiety (adjusted Odds ratio [AOR] 6.934, 95% confidence interval [CI] 2.280-21.081), and a family history of GDM (AOR 1.814, 95% CI 1.185-2.778) were at higher odds of suffering from poor-to-moderate QOL compared to those without a family history. Similarly, those who received insulin, with or without OHA, and/or are on diet modification (AOR 1.955, 95% CI 1.243-3.074) were at higher odds of suffering from poor-to-moderate QOL compared to those receiving OHA and/or diet modification. CONCLUSION Nearly one-quarter of Malaysian women with GDM have poor-to-moderate QOL. GDM women with a family history of depression and/or anxiety, family history of GDM, and those who received insulin, with or without OHA, and/or are on diet modification were associated with poor-to-moderate QOL. TRIAL REGISTRATION NMRR-17-2264-37814.
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Affiliation(s)
- Kai Wei Lee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia. .,Malaysian Research Institute On Ageing, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - Fan Kee Hoo
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Vasudevan Ramachandran
- Malaysian Research Institute On Ageing, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Seng Choi Chong
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Maiza Tusimin
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Faith En Ang
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Noraihan Mohd Nordin
- Department of Obstetrics and Gynaecology, Hospital Kuala Lumpur, 50586, Kuala Lumpur, Malaysia
| | - Navin Kumar Devaraj
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
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Martino G, Caputo A, Bellone F, Quattropani MC, Vicario CM. Going Beyond the Visible in Type 2 Diabetes Mellitus: Defense Mechanisms and Their Associations With Depression and Health-Related Quality of Life. Front Psychol 2020; 11:267. [PMID: 32174865 PMCID: PMC7054284 DOI: 10.3389/fpsyg.2020.00267] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/04/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction Clinical psychological features may impact a person’s aptitude to deal with chronic diseases, leading to emotional distress, suffering, and a worse perceived quality of life (QoL). Chronic diseases are largely represented, and their incidence is constantly increasing all over the world. Type 2 Diabetes Mellitus (T2DM) is one of the most common chronic diseases and it is very difficult to manage, demanding long term self-management, which improves the perceived QoL. The aim of this study was to explore defense mechanisms, depression, QoL, time since diagnosis, and metabolic control in T2DM patients. Methods 51 patients with T2DM were assessed through a psychodiagnostic battery: Beck Depression Inventory-II, the 36-Item Short Form Health Survey, including indexes of Physical and Mental Component Summary and the Defense Mechanisms Inventory. Times since DM diagnosis and glycated hemoglobin values were detected. Results Participants were mainly female (62.74%), with a mean age of 66.1 years. T2M time since diagnosis was 11.77 years (SD = 7.1). Mild depression was detected (with an overall score between 13 and 19). Projection was significantly associated with higher depression and with lower physical well-being; Principalization was negatively associated with depression and positively with both physical and mental well-being. Turning Against Self correlated positively with physical well-being and negatively with mental well-being. Reversal was associated with lower depression and higher mental well-being. A negative high correlation emerged between depression and mental well-being. Finally, a significant relationship was found between Projection and higher time since diagnosis (r = 0.31, p < 0.05). Conclusion The correlations between defense mechanisms, depression and health-related QoL highlight the potential personification and protagonization, which may increase over time due to the illness intrusiveness and worsening of diabetes symptoms. The positive association between defensive strategies and well-being measures should be cautiously considered.
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Affiliation(s)
- Gabriella Martino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Andrea Caputo
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Federica Bellone
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria C Quattropani
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmelo M Vicario
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Italy
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13
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Multidisciplinary Group Education for Gestational Diabetes Mellitus: A Prospective Observational Cohort Study. J Clin Med 2020; 9:jcm9020509. [PMID: 32069855 PMCID: PMC7073549 DOI: 10.3390/jcm9020509] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 01/30/2020] [Accepted: 02/11/2020] [Indexed: 01/01/2023] Open
Abstract
The value of diabetes education, focusing on lifestyle measures, in women with gestational diabetes mellitus (GDM) is acknowledged, but requires intensive education and input of resources if done on an individual basis. Group education could be a valuable alternative to individual education. This study aims to investigate the impact of multidisciplinary group education on women’s knowledge about GDM, education, treatment satisfaction, and emotional status. Two hundred women with GDM were enrolled in a prospective observational study. Dutch speaking women were offered group education at their first visit after GDM diagnosis. Non-Dutch speaking women or women for whom group education was not possible received individual education. Individual follow-up with a dietitian was planned within two weeks for all women. Women receiving individual education (n = 100) were more often from an ethnic minority background compared to women in group education (n = 100) (32.0% (n = 31) vs. 15.3% (n = 15), p = 0.01). Knowledge about GDM significantly improved after education, with few differences between the two education settings. Both patients in group and individual education were equally satisfied with the content and duration of the initial and follow-up education. Of all group participants, 91.8% (n = 90) were satisfied with group size (on average three participants) and 76.5% (n = 75) found that group education fulfilled their expectations. In conclusion, women diagnosed with GDM were overall satisfied with the education session’s content leading to a better understanding of their condition, independent of the education setting. Group education is a valuable alternative to better manage the increasing workload and is perceived as an added value by GDM patients.
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14
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Ardilouze A, Bouchard P, Hivert MF, Simard C, Allard C, Garant MP, Ménard J, Ouellet A, Houde G, Pesant MH, Baillargeon JP, Ardilouze JL. Self-Monitoring of Blood Glucose: A Complementary Method Beyond the Oral Glucose Tolerance Test to Identify Hyperglycemia During Pregnancy. Can J Diabetes 2019; 43:627-635. [DOI: 10.1016/j.jcjd.2019.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/24/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
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Abstract
BACKGROUND A good metabolic control before conception and throughout pregnancy with diabetes decreases the risk of short- and long-term adverse outcomes of the mothers and their offsprings. Insulin treatment remains the gold standard treatment recommended for any type of diabetes. New technologies including new insulins and insulin analogues, continuous subcutaneous insulin infusion without and with sensors, the low-glucose predictive suspension function, and closed-loop systems that persistently and automatically self-adjust according to patients' continuous glucose monitoring readings have expanded the offer to clinicians for achieving tight glucose control. AREAS OF UNCERTAINTY Unsafe effects of insulin and insulin analogues in pregnancy with diabetes could be linked with changes in insulin immunogenicity, teratogenicity, and mitogenicity. Second-generation insulin analogues need to be tested and proven. Effectiveness and safety of new insulin delivery systems in real life of diabetic women in pregnancy need further confirmations. SOURCES MEDLINE, EMBASE, Web of Science, Cochrane Library, randomized controlled trials, systematic review and meta-analysis, observational prospective and retrospective studies, case series reports for the most recent insulin analogues, published in English impacted journals, and consensus statements from scientific societies I excluded 60 from 221 papers as not suitable for the purpose of the subject. RESULTS Subcutaneous insulin infusion can be safely used during pregnancy and delivery of well-trained women. Sensors are increasingly accurate tools that improve the efficacy and safety of integrated systems' functioning. Continuous glucose monitoring provides metrics ("time in range" time in "hypoglycemia" and in "hyperglycemia," glucose variability, average glucose levels in different time intervals) used as a guide to diabetes management; these new metrics are object of discussion in special populations. Randomized controlled trials have shown that sensor-augmented pump therapy improves pregnancy outcomes in women with type 1 diabetes. Closed-loop insulin delivery provides better glycemic control than sensor-augmented pump therapy during pregnancy, before, and after delivery. CONCLUSION Second-generation insulin analogues and newer insulin infusion systems that automatically self-adjust according to patients continuous glucose monitor readings are important tools improving the treatment and quality of life of these women. Multi-institutional and disciplinary teams are working to develop and evaluate a pregnancy-specific artificial pancreas.
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16
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Martino G, Catalano A, Bellone F, Russo GT, Vicario CM, Lasco A, Quattropani MC, Morabito N. As Time Goes by: Anxiety Negatively Affects the Perceived Quality of Life in Patients With Type 2 Diabetes of Long Duration. Front Psychol 2019; 10:1779. [PMID: 31428028 PMCID: PMC6689992 DOI: 10.3389/fpsyg.2019.01779] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/17/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Age-related medical conditions are increasing worldwide. Type 2 Diabetes mellitus (T2DM) represents a chronic disease, which affects a large amount of general population, accounting for over 90% of diabetes mellitus (DM) cases. PURPOSE As psychopathological symptoms frequently occur in medical conditions, our study aimed at exploring whether psychological factors and metabolic control may affect health related quality of life (HRQoL). METHODS Forty five patients with T2DM were consecutively recruited and assessed with a psychodiagnostic battery: Hamilton Anxiety Rating Scale (HAM-A), Beck Depression Inventory II edition (BDI-II) and the 36-Item Short Form Health Survey (SF-36), including indexes Physical and Mental Component Summary (PCS, MCS). Moreover, time since DM diagnosis and glycated hemoglobin (HbA1c) values were detected. RESULTS Participants (mean age 65.3 ± 5.9 years) had a mean time since diagnosis of 11.6 ± 6.7 years, and showed a good metabolic control as highlighted by mean HbA1c values 7.1 ± 0.9%. Median HAM-A score [25(20.7-30.6)], represented high prevalence of anxious symptoms. A moderate expression of depressive symptoms was observed [BDI-II score: 13(8.3-21.4)]. A multiple regression analysis, after correcting for age, BMI, HbA1c value and BDI-II score, showed the perceived quality of life relative to PCS was significantly related to both disease duration (β = -0.55, p = 0.03, SE = 0.25) and HAM-A scores (β = -0.52, p = 0.04, SE = 0.24). Moreover, both HAM-A (β = -0.67, p = 0.01, SE = 0.26) and BDI-II (β = -0.48, p = 0.02, SE = 0.20) scores were independently predictive of MCS. Metabolic control, instead, was not a significant predictor. CONCLUSION Our study suggests a predictive role of both anxiety levels and time since diagnosis in perceived HRQoL in T2DM patients. PCS was associated with anxiety and time since diagnosis and MCS was associated with anxiety and depressive symptoms but not with diabetes duration or metabolic control. These data could be useful to plan T2DM training programs focused on psychological health concerns, possibly leading to a healthy self-management and a better perceived HRQoL, even assisting patients in reducing the negative effect due to the chronicization of T2DM.
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Affiliation(s)
- Gabriella Martino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonino Catalano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Federica Bellone
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Carmelo Mario Vicario
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Italy
| | - Antonino Lasco
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Nunziata Morabito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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17
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Schmidt CB, Voorhorst I, van de Gaar VHW, Keukens A, Potter van Loon BJ, Snoek FJ, Honig A. Diabetes distress is associated with adverse pregnancy outcomes in women with gestational diabetes: a prospective cohort study. BMC Pregnancy Childbirth 2019; 19:223. [PMID: 31269913 PMCID: PMC6610799 DOI: 10.1186/s12884-019-2376-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/24/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Around 12% of pregnant women develop gestational diabetes mellitus (GDM), which is associated with increased health risks for both mother and child and pre- and postpartum depression. Little is known about the relationship of GDM with diabetes-specific emotional distress (diabetes distress). The aims of this study are to assess the prevalence of diabetes distress in GDM and its association with adverse pregnancy outcomes. METHODS A prospective cohort study was carried out in an Amsterdam based teaching hospital with an ethnic diverse population. Women diagnosed with GDM completed a set of questionnaires at three time points. Questionnaires consisted of Problem Areas in Diabetes Scale 5 (PAID-5) for diabetes distress (T0-T1), Patient Health Questionnaire 9 (PHQ-9) for depressive symptoms (T0-T2), and questions to assess adverse pregnancy outcomes (T2). Adverse pregnancy outcomes (collected via self-report and if feasible from the medical records) were defined as hypertension, pre-eclampsia, caesarean section, severe perineal tearing, postpartum hemorrhage, postpartum depression, shoulder dystocia, neonatal hospitalization, macrosomia, jaundice, hypoglycemia and other (among which low heart rate, fever, hypoxia). Adverse pregnancy outcomes were dichotomized into none and 1 or more. Additional information was collected from the medical charts. Missing data were imputed via predictive mean matching and a multivariable logistic regression analysis was performed with diabetes distress, depressive symptoms, socioeconomic status, parity and ethnicity as predictors and age, HbA1c, and BMI as covariates. RESULTS A total of 100 women were included, mean age 32.5 (4.1), mean BMI 26.7 (4.8), 71% were of non-Dutch ethnic background. Elevated diabetes distress (PAID score ≥ 8) was reported by 36% of the women. Multivariable logistic regression analyses revealed that both high diabetes distress (OR 4.70, p = .02) and parity (OR 0.21, p = .02) but not antepartum depressive symptoms were related to adverse pregnancy outcomes. CONCLUSIONS Diabetes distress is likely in women with GDM and our findings suggest an association between both diabetes distress, parity and adverse pregnancy outcomes in women with GDM. This warrants replication and further research into the underlying mechanisms explaining the impact of diabetes distress in GDM and potential interventions to reduce distress.
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Affiliation(s)
- Charlotte B. Schmidt
- Department of Psychiatry, OLVG, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Ilse Voorhorst
- Department of Psychiatry, OLVG, Amsterdam, the Netherlands
| | | | - Anne Keukens
- Department of Gynaecology, OLVG, Amsterdam, the Netherlands
| | | | - Frank J. Snoek
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, OLVG, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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18
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Gestational diabetes mellitus and quality of life during the third trimester of pregnancy. Qual Life Res 2019; 28:1349-1354. [PMID: 30600493 DOI: 10.1007/s11136-018-2090-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE The primary aim of this study was to investigate the effect of gestational diabetes mellitus (GDM) on the quality of life (QoL) of pregnant women during the third trimester of pregnancy. The secondary aim was to compare the QoL of pregnant women with GDM according to their therapeutic approach. This is the first study of this kind conducted in Greece. METHODS A case-control study with 62 pregnant women (31 with GDM and 31 with uncomplicated pregnancy), during the third trimester of pregnancy. QoL and Health Related QoL were studied with the use of three questionnaires (EQ-5D-5L, WHOQOL-BREF and ADDQoL). RESULTS A decrease in the QoL was found in pregnant women with GDM compared with pregnant women with uncomplicated pregnancy (p < 0.05) regarding both social life and health scales. On the contrary, there was no difference in the QoL between pregnant women with GDM who followed different treatment approaches (diet or insulin). CONCLUSIONS The diagnosis of GDM is associated with a reduction in the QoL of pregnant women during the third trimester of pregnancy, while the type of treatment does not seem to further affect it. More studies should be conducted so that the modifiers of this association can be clarified.
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Lapolla A, Scibetta D, Gallina P, Iorizzo G, Dalfrà MG, Visentin S, Nardelli GB, Vettor R. Innovative clinical pathways for obese pregnant women: design and feasibility of the Padua project (North-Eastern Italy). J Endocrinol Invest 2018; 41:647-653. [PMID: 29116583 DOI: 10.1007/s40618-017-0780-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 10/23/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Obesity during pregnancy can adversely affect the wellbeing of the mother and the newborn, as well as the latter's long-term health. Preconception counseling, careful prenatal management, and strict follow-up during pregnancy are, therefore, essential for obese fertile women in order to prevent the negative effects of obesity. METHODS In this setting, we developed a project that consisted in creating an integrated network of primary, secondary, and tertiary care providers and designing new clinical pathways for managing pregnancy in obese women. RESULTS Two distinct pathways were devised: a Pre-Gestational Pathway for programming a pregnancy in obese women; and a Gestational Pathway for the clinical management of their pregnancy. DISCUSSION Judging from the preliminary results of our study, the latter (Gestational) pathway seems to be successful, since there has been a gradual increase in the number of women using it, and these women have reported having no difficulty in accessing the services involved. It is noteworthy that immigrant women (who accounted for 60% of the women using the pathway) also reported no access issues. The pre-gestational pathway was very little used, however, accounting for only 2% of the appointments made with the services involved. In conclusion, the key to success in managing pregnancy in obese women lies in sharing the various different health care competences required and taking the local resources into account. The prevention of obesity in women of fertile age remains the main problem, however, and further efforts are needed in this setting.
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Affiliation(s)
- A Lapolla
- DIMED-Diabetology and Dietetics Unit, Padova University, Via Giustiniani n 2, 35100, Padua, Italy.
| | | | - P Gallina
- AULSS Euganea, LHA Padova, Padua, Italy
| | - G Iorizzo
- AULSS Euganea, LHA Padova, Padua, Italy
| | - M G Dalfrà
- DIMED-Diabetology and Dietetics Unit, Padova University, Via Giustiniani n 2, 35100, Padua, Italy
| | - S Visentin
- DSDB-Obstetrics and Gynecology Clinic, Padova University, Padua, Italy
| | - G B Nardelli
- DSDB-Obstetrics and Gynecology Clinic, Padova University, Padua, Italy
| | - R Vettor
- DIMED-Medical Clinic III, Padova University, Padua, Italy
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Martis R, Brown J, McAra-Couper J, Crowther CA. Enablers and barriers for women with gestational diabetes mellitus to achieve optimal glycaemic control - a qualitative study using the theoretical domains framework. BMC Pregnancy Childbirth 2018; 18:91. [PMID: 29642898 PMCID: PMC5896082 DOI: 10.1186/s12884-018-1710-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/16/2018] [Indexed: 12/15/2022] Open
Abstract
Background Glycaemic target recommendations vary widely between international professional organisations for women with gestational diabetes mellitus (GDM). Some studies have reported women’s experiences of having GDM, but little is known how this relates to their glycaemic targets. The aim of this study was to identify enablers and barriers for women with GDM to achieve optimal glycaemic control. Methods Women with GDM were recruited from two large, geographically different, hospitals in New Zealand to participate in a semi-structured interview to explore their views and experiences focusing on enablers and barriers to achieving optimal glycaemic control. Final thematic analysis was performed using the Theoretical Domains Framework. Results Sixty women participated in the study. Women reported a shift from their initial negative response to accepting their diagnosis but disliked the constant focus on numbers. Enablers and barriers were categorised into ten domains across the three study questions. Enablers included: the ability to attend group teaching sessions with family and hear from women who have had GDM; easy access to a diabetes dietitian with diet recommendations tailored to a woman’s context including ethnic food and financial considerations; free capillary blood glucose (CBG) monitoring equipment, health shuttles to take women to appointments; child care when attending clinic appointments; and being taught CBG testing by a community pharmacist. Barriers included: lack of health information, teaching sessions, consultations, and food diaries in a woman’s first language; long waiting times at clinic appointments; seeing a different health professional every clinic visit; inconsistent advice; no tailored physical activities assessments; not knowing where to access appropriate information on the internet; unsupportive partners, families, and workplaces; and unavailability of social media or support groups for women with GDM. Perceived judgement by others led some women only to share their GDM diagnosis with their partners. This created social isolation. Conclusion Women with GDM report multiple enablers and barriers to achieving optimal glycaemic control. The findings of this study may assist health professionals and diabetes in pregnancy services to improve their care for women with GDM and support them to achieve optimal glycaemic control.
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Affiliation(s)
- Ruth Martis
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Julie Brown
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Judith McAra-Couper
- Faculty of Health & Environmental Sciences, AUT, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
| | - Caroline A Crowther
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
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Burlina S, Dalfrà MG, Visentin S, Valentini R, Capovilla F, Lapolla A. Team management of gestational diabetes: a training experience. Acta Diabetol 2017; 54:881-883. [PMID: 28550359 DOI: 10.1007/s00592-017-1003-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- S Burlina
- Department of Medicine - DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
| | - M G Dalfrà
- Department of Medicine - DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - S Visentin
- Department of Women's and Children's Health, University of Padova, Padua, Italy
| | - R Valentini
- Department of Medicine - DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - F Capovilla
- Department of Medicine - DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - A Lapolla
- Department of Medicine - DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
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Miazgowski T, Bikowska M, Ogonowski J, Taszarek A. The Impact of Health Locus of Control and Anxiety on Self-Monitored Blood Glucose Concentration in Women with Gestational Diabetes Mellitus. J Womens Health (Larchmt) 2017; 27:209-215. [PMID: 28829663 DOI: 10.1089/jwh.2017.6366] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the associations between health locus of control (HLC), anxiety, and glycemic control from the time of diagnosis of gestational diabetes (GDM) to the end of pregnancy. METHODS The study group comprised 165 women with GDM. Baseline HLC (∼27 weeks of gestation) was assessed by the Multidimensional HLC Scale. The level of anxiety was measured at baseline and follow-up (37 weeks of gestation) by the State-Trait Anxiety Inventory. Using questionnaires, we collected information about the level of fear related to measuring blood glucose several times per day, dietary regimen, and insulin therapy, as well as fear for the baby and its health, patient's own health, and having diabetes in the next pregnancy. Glycemic control was evaluated by self-monitored fasting and postprandial blood glucose levels. RESULTS Baseline state anxiety was significantly higher than trait anxiety. From baseline to follow-up, the state anxiety and percentage of women with increased fear for their infant's health, diabetic diet, self-monitoring of blood glucose, and insulin injection significantly decreased. In comparison to women with blood glucose in the low tertile, those with blood glucose in the high tertile had significantly higher scores in the chance HLC subscale and a similar level of state anxiety. Blood glucose was positively correlated with the chance HLC score. CONCLUSIONS Chance HLC beliefs seem to be associated with poorer glycemic outcomes in women with GDM. Our results suggest the need for further efforts to reduce the GDM-associated state anxiety.
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Affiliation(s)
- Tomasz Miazgowski
- 1 Department of Hypertension and Internal Medicine, Pomeranian Medical University , Szczecin, Poland
| | - Magdalena Bikowska
- 2 Department of Long-Term Care, Pomeranian Medical University , Szczecin, Poland
| | - Jarosław Ogonowski
- 3 Department of Civilization Diseases and Treatment of Obesity, Pomeranian Medical University , Szczecin, Poland
| | - Aleksandra Taszarek
- 1 Department of Hypertension and Internal Medicine, Pomeranian Medical University , Szczecin, Poland
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Orbay E, Tüzün S, Çınkıt B, Ölmez MB, Tekin S, Purut E, Bulut S, Sargın M. Gestasyonel Diabetes Mellitusu Olan Gebelerde Antenatal Anksiyete. ANKARA MEDICAL JOURNAL 2017. [DOI: 10.17098/amj.323187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Evaluation of the quality of life of pregnant women from 2005 to 2015. Eur J Obstet Gynecol Reprod Biol 2017; 214:115-130. [PMID: 28525824 DOI: 10.1016/j.ejogrb.2017.04.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/07/2017] [Accepted: 04/27/2017] [Indexed: 11/21/2022]
Abstract
Over the past two decades, quality of life has become an essential preoccupation in the care of patients. Many measuring instruments are available to assess physical, psychological and social quality of life. These tools allow healthcare professionals to determine the best quality of their patients. However, the quality of life for the pregnant woman seems to be little studied. This article presents the results of a bibliographic review of publications between 2005 and 2015 - referenced in PUBMED and COCHRANE - on the quality of life of pregnant women giving birth after the 22nd week of amenorrhea. The articles were selected by a reading committee. 195 publications responding to keywords were identified. 75 articles on the problem were selected. The main countries that have published on this subject are Iran (n=11) and Brazil (n=9). France ranks 17th with only one publication. 74% of articles deal with quality of life for pathological pregnancies (gestational or pre-existing pathologies). 23 pathologies were identified, mainly depression (20% of items). This review reveals a growing global interest in quality of life in pregnant women. However, few studies evaluate the impact of care in terms of quality of life in pregnant women, contrary to the recommendations of different health authorities. Finally, the analysis of the various articles shows that, in general, few measurements are made to evaluate the quality of life, not requiring a standardized curve of quality of life during pregnancy. There is thus a significant lack of data to establish a standardized curve for the quality of life of pregnant women, which allows a simple comparison of quality of life measures according to the different clinical management.
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Marchetti D, Carrozzino D, Fraticelli F, Fulcheri M, Vitacolonna E. Quality of Life in Women with Gestational Diabetes Mellitus: A Systematic Review. J Diabetes Res 2017; 2017:7058082. [PMID: 28326332 PMCID: PMC5343261 DOI: 10.1155/2017/7058082] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 02/09/2017] [Indexed: 12/16/2022] Open
Abstract
Background and Objective. Diagnosis of Gestational Diabetes Mellitus (GDM) could significantly increase the likelihood of health problems concerning both potential risks for the mother, fetus, and child's development and negative effects on maternal mental health above all in terms of a diminished Quality of Life (QoL). The current systematic review study is aimed at further contributing to an advancement of knowledge about the clinical link between GDM and QoL. Methods. According to PRISMA guidelines, PubMed, Web of Science, Scopus, and Cochrane databases were searched for studies aimed at evaluating and/or improving levels of QoL in women diagnosed with GDM. Results. Fifteen research studies were identified and qualitatively analyzed by summarizing results according to the following two topics: GDM and QoL and interventions on QoL in patients with GDM. Studies showed that, in women with GDM, QoL is significantly worse in both the short term and long term. However, improvements on QoL can be achieved through different intervention programs by enhancing positive diabetes-related self-management behaviors. Conclusion. Future studies are strongly recommended to further examine the impact of integrative programs, including telemedicine and educational interventions, on QoL of GDM patients by promoting their illness acceptance and healthy lifestyle behaviors.
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Affiliation(s)
- Daniela Marchetti
- Department of Psychological Health and Territorial Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Danilo Carrozzino
- Department of Psychological Health and Territorial Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Federica Fraticelli
- Department of Medicine and Aging, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Mario Fulcheri
- Department of Psychological Health and Territorial Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Ester Vitacolonna
- Department of Medicine and Aging, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
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Martis R, Brown J, Crowther CA. Views and Experiences of New Zealand Women with Gestational Diabetes in Achieving Glycaemic Control Targets: The Views Study. J Diabetes Res 2017; 2017:2190812. [PMID: 29226155 PMCID: PMC5684580 DOI: 10.1155/2017/2190812] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/12/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Optimal glycaemic control in women with gestational diabetes mellitus (GDM) reduces maternal and infant morbidity. METHOD A survey was administered to women diagnosed with GDM to explore their views and experiences in achieving optimal glycaemic control. RESULTS Sixty women participated. Enablers included being taught to test capillary blood glucose in group settings where the health professional demonstrated this on themselves first (60, 100%); health professionals listening (41, 68%); being reminded to perform blood glucose testing (33, 55%); and being provided healthy meals by friends and family (28, 47%). Barriers included not having information in a woman's first language (33, 55%); being offered unhealthy food (19, 31%); not being believed by health professionals (13, 21%); receiving inconsistent information by health professionals (10, 16%); never being seen twice by the same health professional (8, 13%); and long waiting hours at clinics (7, 11%). Two-thirds of women (37, 62%) reported that food costs were not a barrier, but that they were always or frequently hungry. CONCLUSION Optimising experiences for women with GDM for achieving glycaemic control and overcoming barriers, regardless of glycaemic targets, requires further focus on providing meaningful health literacy and support from health professionals, family, friends, and work colleagues.
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Affiliation(s)
- Ruth Martis
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Julie Brown
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Caroline A. Crowther
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
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Khooshehchin TE, Keshavarz Z, Afrakhteh M, Shakibazadeh E, Faghihzadeh S. Perceived needs in women with gestational diabetes: A qualitative study. Electron Physician 2016; 8:3412-3420. [PMID: 28163857 PMCID: PMC5279975 DOI: 10.19082/3412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 07/13/2016] [Indexed: 11/20/2022] Open
Abstract
Introduction Diabetes is the most common medical complication of pregnancy. It can be associated with many complications for mother and fetus. Gestational diabetes is also one of the main health issues in Iran. Therefore, the present study is aimed at a deeper understanding of women’s experiences of gestational diabetes and their perceived needs to inform future lifestyle interventions. Methods This qualitative content analysis study was carried out in 2015. Participants were pregnant women diagnosed with gestational diabetes in the 24th to 36th week of pregnancy, who were referred to the clinics affiliated with Shahid Beheshti Medical Science University in Tehran, Iran. In-depth interviews were conducted with participants, using semi-structured questions. Interviews were audio taped and transcribed verbatim. Conventional content analysis was carried out for data analysis. Interviews continued until data saturation was obtained. Data were coded in MAXQDA software (version 11). Results Content analysis highlighted two themes; educational needs and need to support. The former was featured with five main categories: information sources, education process, unknown and known, weaknesses of public information system, and eagerness to learn. The latter was featured with two main categories: family support and social support. Conclusion Clarifying the needs of the mothers with gestational diabetes, leads to better and proper education planning and a program toward the improvement of health, self-care, and prevention of diabetes.
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Affiliation(s)
- Taraneh Emamgoli Khooshehchin
- Student Research Office, Ph.D. Candidate, Department of Reproductive Health, School of Nursing and Midwifery, International Branch, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohre Keshavarz
- Assistant Professor, Department of Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Afrakhteh
- Department of Obstetrics and Gynecology of Shohada Tajresh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Shakibazadeh
- Assistant Professor, Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Soghrat Faghihzadeh
- Department of Biostatistics, Zanjan University of Medical Sciences, Zanjan, Iran
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Hernandez TL. Carbohydrate Content in the GDM Diet: Two Views: View 1: Nutrition Therapy in Gestational Diabetes: The Case for Complex Carbohydrates. Diabetes Spectr 2016; 29:82-8. [PMID: 27182176 PMCID: PMC4865387 DOI: 10.2337/diaspect.29.2.82] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IN BRIEF Restriction of dietary carbohydrate has been the cornerstone for treatment of gestational diabetes mellitus (GDM). However, there is evidence that a balanced liberalization of complex carbohydrate as part of an overall eating plan in GDM meets treatment goals and may mitigate maternal adipose tissue insulin resistance, both of which may promote optimal metabolic outcomes for mother and offspring.
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Affiliation(s)
- Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes and College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, CO
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Meneguin S, Xavier CDL, Santana DGD. Qualidade de vida de cardiopatas durante a gestação e após o parto. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Analisar as mudanças na qualidade de vida em pacientes cardiopatas durante a gestação e após o parto, e estudar as correlações das características sociodemográficas e clínicas com medidas de qualidade de vida no puerpério. Métodos Estudo prospectivo que incluiu 33 gestantes selecionadas por amostra não probabilística. O instrumento de pesquisa foi o questionário SF-36. Para a comparação das médias dos escores dos domínios do SF-36 foi utilizado o test t de Student e o coeficiente de Spearman para possíveis correlações. Resultados Comparada à gestação, houve melhora na avaliação de qualidade de vida após o parto, exceto nos domínios estado geral de saúde e vitalidade. A variável planejamento da gestação indicou correlação positiva com o domínio saúde mental e negativa com aspectos emocionais no puerpério. Conclusão Após o parto houve melhora na qualidade de vida. Não planejar a gestação contribuiu melhorou a saúde mental, mas agravou os aspectos emocionais no puerpério.
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Bień A, Rzońca E, Kańczugowska A, Iwanowicz-Palus G. Factors Affecting the Quality of Life and the Illness Acceptance of Pregnant Women with Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010068. [PMID: 26703697 PMCID: PMC4730459 DOI: 10.3390/ijerph13010068] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 12/16/2022]
Abstract
The paper contains an analysis of the factors affecting the quality of life (QoL) and the illness acceptance of diabetic pregnant women. The study was performed between January and April, 2013. It included 114 pregnant women with diabetes, hospitalized in the High Risk Pregnancy Wards of several hospitals in Lublin, Poland. The study used a diagnostic survey with questionnaires. The research instruments used were: The WHOQOL-Bref questionnaire and the Acceptance of Illness Scale (AIS). The women’s general quality of life was slightly higher than their perceived general health. A higher quality of life was reported by women with a very good financial standing, very good perceived health, moderate self-reported knowledge of diabetes, and also by those only treated with diet and stating that the illness did not interfere with their lives (p < 0.05). Women with a very good financial standing (p < 0.009), high self-reported health (p < 0.002), and those treated with by means of a diet (p < 0.04) had a higher acceptance of illness. A higher acceptance of illness contributes to a higher general quality of life and a better perception of one’s health.
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Affiliation(s)
- Agnieszka Bień
- Independent Obstetric Skills Unit, Faculty of Health Sciences, Medical University of Lublin, 4 Staszica St., 20-081 Lublin, Poland.
| | - Ewa Rzońca
- Independent Obstetric Skills Unit, Faculty of Health Sciences, Medical University of Lublin, 4 Staszica St., 20-081 Lublin, Poland.
| | - Angelika Kańczugowska
- Neonatology Ward, Independent Public Teaching Hospital No. 4 in Lublin, 8 Jaczewskiego St., 20-954 Lublin, Poland.
| | - Grażyna Iwanowicz-Palus
- Independent Obstetric Skills Unit, Faculty of Health Sciences, Medical University of Lublin, 4 Staszica St., 20-081 Lublin, Poland.
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Danyliv A, Gillespie P, O'Neill C, Noctor E, O'Dea A, Tierney M, McGuire BE, Glynn LG, Dunne FP. Health related quality of life two to five years after gestational diabetes mellitus: cross-sectional comparative study in the ATLANTIC DIP cohort. BMC Pregnancy Childbirth 2015; 15:274. [PMID: 26496985 PMCID: PMC4619994 DOI: 10.1186/s12884-015-0705-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/14/2015] [Indexed: 12/26/2022] Open
Abstract
Background There is no consensus on the effect of gestational diabetes mellitus (GDM) on health-related quality of life (HRQOL) for the mother in the short or long term. In this study we examined HRQOL in a group of women who had GDM in the index pregnancy 2 to 5 years previously and compared it to a group of women with normal glucose tolerance (NGT) in the index pregnancy during the same time period. Methods The sample included 234 women who met International Association of Diabetes Study Groups (IADPSG) criteria for GDM in the index pregnancy and 108 who had NGT. The sample was drawn from the ATLATIC-DIP (Diabetes In Pregnancy) cohort – a network of antenatal centers along the Irish Atlantic seaboard serving a population of approximately 500,000 people. HRQOL was measured using the visual analogue component of the EQ-5D-3 L instrument in a cross-sectional survey. Results The difference in HRQOL between GDM and NGT groups was not significant when adjusted for the effects of the covariates. HRQOL was negatively affected by increased BMI and abnormal glucose tolerance post-partum in the NGT group. Moderate alcohol consumption was positively associated with HRQOL in the NGT group only. The negative association with smoking on HRQOL was substantially higher in the GDM group. Conclusions A diagnosis of GDM does not appear to have an adverse effect on HRQOL, 2 to 5 years after the index pregnancy. On the contrary, its diagnosis might lead to the development of coping strategies, which, consequently attenuates the adverse effect of the subsequent acquisition of abnormal glucose tolerance post-partum on HRQOL. Women whose pregnancy was affected by GDM are more susceptible to the adverse effects on HRQOL of alcohol use and tobacco smoking. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0705-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andriy Danyliv
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland. .,School of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland.
| | - Paddy Gillespie
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland.
| | - Ciaran O'Neill
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland.
| | - Eoin Noctor
- School of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland.
| | - Angela O'Dea
- School of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland. .,Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland.
| | - Marie Tierney
- School of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland. .,Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland.
| | - Brian E McGuire
- School of Psychology, National University of Ireland, Galway, Ireland. .,Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland.
| | - Liam G Glynn
- Discipline of General Practice, National University of Ireland, Galway, Ireland.
| | - Fidelma P Dunne
- School of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland. .,Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland.
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Marquesim NAQ, Cavassini ACM, Morceli G, Magalhães CG, Rudge MVC, Calderon IDMP, Kron MR, Lima SAM. Depression and anxiety in pregnant women with diabetes or mild hyperglycemia. Arch Gynecol Obstet 2015; 293:833-7. [DOI: 10.1007/s00404-015-3838-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 07/28/2015] [Indexed: 10/23/2022]
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Kopec JA, Ogonowski J, Rahman MM, Miazgowski T. Patient-reported outcomes in women with gestational diabetes: a longitudinal study. Int J Behav Med 2015; 22:206-13. [PMID: 25106672 DOI: 10.1007/s12529-014-9428-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Gestational Diabetes Mellitus (GDM) is a common health problem among pregnant women and may be associated with distress. PURPOSE The purpose of the study was to describe changes in patient-reported outcomes in women with GDM and identify factors associated with increased distress in these patients. RESEARCH DESIGN The study was conducted in 205 women diagnosed with GDM. Study participants underwent a physical examination and completed a questionnaire two times during pregnancy. On average, the questionnaire was completed at 27 weeks of gestation at baseline and 36 weeks at follow-up. The questionnaire included socio-demographic and clinical variables, standardized patient-reported outcome measures, and questions about the impact of GDM on daily life, satisfaction with care, knowledge about GDM, and social and professional support. Our main outcome of interest was diabetes-related distress, measured by the Problem Areas in Diabetes (PAID) questionnaire. Data were analyzed using descriptive statistics and multivariable regression models. RESULTS At baseline, 80% of the women were satisfied with their diabetes care and 58% said they managed their diabetes well. The proportion reporting little or no knowledge of GDM dropped from almost 50% at baseline to 14% at follow-up. However, the proportion reporting that GDM affected their social life increased from 26 to 35%, and the proportion reporting interference with family life increased from 14 to 26%. Insulin treatment, frequency of blood glucose measurements, lack of knowledge about GDM, and lack of support from family and health care providers were strongly and significantly associated with distress. CONCLUSION In women with GDM, intensified treatment and lack of informational and social support are associated with distress. These aspects of GDM care appear to be appropriate targets for future research and interventions aimed at reducing the level of distress in these patients.
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Affiliation(s)
- J A Kopec
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada,
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Serehi AA, Ahmed AM, Shakeel F, Alkhatani K, El-Bakri NK, Buhari BAM, Mohareb UA, Aljohani N. A comparison on the prevalence and outcomes of gestational versus type 2 diabetes mellitus in 1718 Saudi pregnancies. Int J Clin Exp Med 2015; 8:11502-11507. [PMID: 26379970 PMCID: PMC4565353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/23/2015] [Indexed: 06/05/2023]
Abstract
The presence of either diabetes mellitus type 2 (DMT2) or GDM constitute a high-risk pregnancy. Given the high rate of DMT2 and GDM in the kingdom of Saudi Arabia (KSA), no study has ever compared whether GDM outcomes are comparable to those with DMT2. The present study aims to compare for the first time, maternal and neonatal outcomes among Saudi patients with GDM, DMT2 and non-DM groups. This is a retrospective study covering data from 1718 pregnant patients admitted at King Fahad Medical City, Riyadh, KSA from April 2011 to March 2013. The prevalence of GDM was 13.8%, DMT2 was 0.9%. DMT2 group had the highest mean parity and shortest mean gestational age as compared to other groups. Half of all the subjects in the DMT2 group also experienced preterm labor, as opposed to only 10% in GDM and 14% in the non-DM group, respectively. Finally, neonates delivered by DMT2 mothers had the highest percentage of admissions to NICU (33%) as compared to 10% in the non-DM group and only 5% in the GDM group. Outcomes of the GDM group are almost comparable with the non-DM group. While the results of the present study reflect the efficient management of GDM cases in Saudi patients, DMT2 complicated pregnancies, which are considered to be at a much higher risk for maternal and neonatal complications, should be given equally special attention.
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Affiliation(s)
- Amal Al Serehi
- Department of Maternal-Fetal Medicine, King Fahad Medical CityRiyadh 59046, Saudi Arabia
| | - Amjad M Ahmed
- Women’s Specialized Hospital, Riyadh, King Fahad Medical CityRiyadh 59046, Saudi Arabia
| | - Farah Shakeel
- Prince Mutaib Chair for Biomarkers of Osteoporosis, College of Science, King Saud UniversityRiyadh 11451, Saudi Arabia
| | - Khadija Alkhatani
- Prince Mutaib Chair for Biomarkers of Osteoporosis, College of Science, King Saud UniversityRiyadh 11451, Saudi Arabia
| | - Nahid K El-Bakri
- Research Center of Medicine, King Saud Bin Abdulaziz University for Health SciencesRiyadh 22490, Saudi Arabia
| | - Badr Aldin M Buhari
- Research Center of Medicine, King Saud Bin Abdulaziz University for Health SciencesRiyadh 22490, Saudi Arabia
| | - Uhoud Al Mohareb
- Research Center of Medicine, King Saud Bin Abdulaziz University for Health SciencesRiyadh 22490, Saudi Arabia
| | - Naji Aljohani
- Research Center of Medicine, King Saud Bin Abdulaziz University for Health SciencesRiyadh 22490, Saudi Arabia
- Specialized Diabetes and Endocrine Center, King Fahad Medical CityRiyadh 59046, Saudi Arabia
- Prince Mutaib Chair for Biomarkers of Osteoporosis, College of Science, King Saud UniversityRiyadh 11451, Saudi Arabia
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Hui AL, Sevenhuysen G, Harvey D, Salamon E. Barriers and coping strategies of women with gestational diabetes to follow dietary advice. Women Birth 2014; 27:292-7. [PMID: 25096174 DOI: 10.1016/j.wombi.2014.07.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/13/2014] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To understand barriers and coping strategies of women with gestational diabetes (GDM) to follow dietary advice. DESIGN Qualitative study. PARTICIPANTS Thirty women with GDM from the Winnipeg area participated. Each participant completed a Food Choice Map (FCM) semi-structured interview and a demographic questionnaire. MAJOR OUTCOME MEASURES Underlying beliefs of women with GDM and factors that hinder following dietary advice. ANALYSIS Qualitative data analyzed using constant comparative method to identify emergent themes of factors and beliefs that affected following dietary advice. Themes were categorized within the Integrative Model of Behavioral Prediction. RESULTS GDM women faced challenges and barriers when (1) personal food preference conflicted with dietary advice; (2) eating in different social environments where food choice and portions were out of control and food choice decisions were affected by social norms; (3) lack of knowledge and skills in dietary management and lack of a tailored dietary plan. CONCLUSIONS AND IMPLICATIONS Quick adaptation to dietary management in a short time period created challenges for women with GDM. Stress and anxiety were reported when women talked about following dietary advice. Tailored educational and mental health consultation with consideration of the barriers may promote dietary compliance and overall better health.
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Affiliation(s)
- Amy Leung Hui
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Gustaaf Sevenhuysen
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dexter Harvey
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Salamon
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Hui AL, Sevenhuysen G, Harvey D, Salamon E. Stress and Anxiety in Women With Gestational Diabetes During Dietary Management. DIABETES EDUCATOR 2014; 40:668-77. [DOI: 10.1177/0145721714535991] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To explore the stress and anxiety experiences during dietary management in women with gestational diabetes (GDM). Methods Thirty women with GDM from the Winnipeg area participated in the mixed methods study. Each participant completed a Food Choice Map semistructured interview, a Perceived Stress Scale, a Pregnancy Anxiety Scale, a State-Trait Anxiety Inventory–Trait questionnaire, and a demographic questionnaire. Stress and anxiety experiences were identified from interview transcripts and categorized into themes based on the constant comparative method. Questionnaire scores aided in interpreting the stress and anxiety experience in the qualitative data. Results Three major themes were generated from the interviews: (1) stress related to GDM diagnosis and the perception of a high risk pregnancy; (2) stress over losing control of GDM during the process of dietary management; and (3) anxiety related to the fear of maternal and infant complications. Women on insulin experienced significantly higher levels of perceived stress ( P < .01), and the dietary management stress was more prevalent in women using insulin compared to the ones on diet treatment only (Fisher exact test, P < .01). Unhealthy diet coping strategies occurred with the stress and anxiety. Conclusions Stress and anxiety were associated with different contexts in this study sample. Women who were on insulin experienced significantly higher levels of perceived stress related to dietary management.
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Affiliation(s)
- Amy Leung Hui
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (Ms Hui, Dr Salamon)
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (Dr Sevenhuysen, Dr Harvey)
| | - Gustaaf Sevenhuysen
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (Ms Hui, Dr Salamon)
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (Dr Sevenhuysen, Dr Harvey)
| | - Dexter Harvey
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (Ms Hui, Dr Salamon)
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (Dr Sevenhuysen, Dr Harvey)
| | - Elizabeth Salamon
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (Ms Hui, Dr Salamon)
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (Dr Sevenhuysen, Dr Harvey)
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Kalra B, Sridhar GR, Madhu K, Balhara YPS, Sahay RK, Kalra S. Psychosocial management of diabetes in pregnancy. Indian J Endocrinol Metab 2013; 17:815-8. [PMID: 24083162 PMCID: PMC3784864 DOI: 10.4103/2230-8210.117216] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
This consensus based national guideline addresses the need for psychological, psychiatric and social assessment, as well as management, in antenatal women with diabetes. It builds upon the earlier Indian guidelines on psychological management of diabetes, and should be considered as an addendum to the parent guideline.
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Affiliation(s)
- Bharti Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - G. R. Sridhar
- Endocrine and Diabetes Centre, Andhra University, Vishakhapatnam, India
| | - K. Madhu
- Department of Psychology, Andhra University, Vishakhapatnam, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre, AIIMS, New Delhi,, India
| | | | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
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Hunsberger ML, Donatelle RJ, Lindsay K, Rosenberg KD. Physician care patterns and adherence to postpartum glucose testing after gestational diabetes mellitus in Oregon. PLoS One 2012; 7:e47052. [PMID: 23071709 PMCID: PMC3469538 DOI: 10.1371/journal.pone.0047052] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 09/07/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study examines obstetrician/gynecologists and family medicine physicians' reported care patterns, attitudes and beliefs and predictors of adherence to postpartum testing in women with a history of gestational diabetes mellitus. RESEARCH DESIGN AND METHODS In November-December 2005, a mailed survey went to a random, cross-sectional sample of 683 Oregon licensed physicians in obstetrician/gynecologists and family medicine from a population of 2171. RESULTS Routine postpartum glucose tolerance testing by both family physicians (19.3%) and obstetrician/gynecologists physicians (35.3%) was reportedly low among the 285 respondents (42% response rate). Factors associated with high adherence to postpartum testing included physician stated priority (OR 4.39, 95% CI: 1.69-7.94) and physician beliefs about norms or typical testing practices (OR 3.66, 95% CI: 1.65-11.69). Specialty, sex of physician, years of practice, location, type of practice, other attitudes and beliefs were not associated with postpartum glucose tolerance testing. CONCLUSIONS Postpartum glucose tolerance testing following a gestational diabetes mellitus pregnancy was not routinely practiced by responders to this survey. Our findings indicate that physician knowledge, attitudes and beliefs may in part explain suboptimal postpartum testing. Although guidelines for postpartum care are established, some physicians do not prioritize these guidelines in practice and do not believe postpartum testing is the norm among their peers.
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Affiliation(s)
- Monica L Hunsberger
- University of Gothenburg, Public Health Epidemiology and Community Medicine, Gothenburg, Sweden.
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